The roles of periodontal ligament mechanoreceptors in the reflex control of human jaw-closing muscles

The reciprocal jaw-muscle reflexes elicited by anterior- and back-tooth-contacts-a perspective to explain the control of the masticatory muscles

AIMS

Tooth-contact sensations are considered essential to boost jaw adductor muscles during mastication. However, no previous studies have explained the importance of the inhibitory reflex of human anterior-tooth (ANT)-contacts in mastication. Here I present the "reciprocal reflex-control-hypothesis" of mammalian mastication.

SUBJECTS AND SETTING OF THE STUDY

I demonstrate the hypothesis with the live kinematics of free jaw-closures as inferred from T-Scan recordings of dental patients.

RESULTS

The jaw-closures started with negligible force, predominantly with ANT-contacts (the AF-bites). The first ANT-contact inhibited the first kinematic tilt of the mandible, whereas the bites starting from a back-tooth (BAT)-contact (the BF-bites) accelerated the first tilt. The second tilt established a low-force static tripod of the ANT- and bilateral BAT-contacts for a fixed mandible-maxilla relation. Thereafter, semi-static bite force increased rapidly, relatively more in the BAT-area.

DISCUSSION AND CONCLUSIONS

In the vertical-closure phase of chewing, the primate joint-fulcrum (class 3 lever) conflicts with the food-bolus-fulcrum in the BAT-area (class 1 lever). The resilient class 3 and 1 lever systems are superseded by an almost static mechanically more advantageous class 2 lever with a more rigid fulcrum at the most anterior ANT-contact. For humans, the class 2 levered delivery of force also enables forceful horizontal food grinding to be extended widely to the BAT-area.

Influence of surgical orthodontic treatment on masticatory function in skeletal Class III patients

Skeletal Class III patients exhibit malocclusion characterised by Angle Class III and anterior crossbite, and their occlusion shows total or partially lateral crossbite of the posterior teeth. Most patients exhibit lower bite force and muscle activity than non-affected subjects. While orthognathic surgery may help improve masticatory function in these patients, its effects have not been fully elucidated. The aims of the study were to evaluate jaw movement and the electromyographic (EMG) activity of masticatory muscles before and after orthognathic treatment in skeletal Class III patients in comparison with control subjects with normal occlusion. Jaw movement variables and EMG data were recorded in 14 female patients with skeletal Class III malocclusion and 15 female controls with good occlusion. Significant changes in jaw movement, from a chopping to a grinding pattern, were observed after orthognathic treatment (closing angle P < 0.01; cycle width P < 0.01), rendering jaw movement in the patient group similar to that of the control group. However, the grinding pattern in the patient group was not as broad as that of controls. The activity indexes, indicating the relative contributions of the masseter and temporalis muscles (where a negative value corresponds to relatively more temporalis activity and vice versa) changed from negative to positive after treatment (P < 0.05), becoming similar to those of control subjects. Our findings suggest that orthognathic treatment in skeletal Class III patients improves the masticatory chewing pattern and muscle activity. However, the chewing pattern remains incomplete compared with controls.

Quantification of jaw reflexes evoked by natural tooth contact in human subjects

Inhibitory jaw reflexes are believed to be important for protecting the teeth and temporo-mandibular structures from damage during sudden or forceful biting or mastication. Accordingly, alterations in these reflexes are sometimes implicated in aetiologies proposed for oro-facial pain syndromes, although the association is not well-established. We now aim to develop a method for quantifying objectively inhibitory jaw reflexes evoked by natural tooth contact. In the longer term, this may provide a new approach to examining the association of altered reflexes and clinical conditions. Eighteen subjects gave their written, informed consent, and were recruited to participate in this study. They were instructed to clench their teeth together in response to visual cues. They performed two such tasks twenty times: from the jaw postural position and from a more open position with the jaws set 10mm apart. Both tasks produced a rapid rise then stabilisation in electromyographic activity in the masseter muscle. This was always interrupted by a large inhibitory reflex starting 11.1±1.5 ms (mean±SD) after tooth contact. The inhibitions produced during the second task were similar but of significantly longer duration (24.3±6.4 vs 18.4±6.5 ms, P=0.0003, paired t-test) and greater magnitude (measured as an integral of the waveform: 1577±478 vs 1279±425%.ms, P=0.007, paired t-test). Interestingly, in a minority (13%) of the tasks, a second inhibition with a longer latency (50.9±0.9 ms) was also observed. Thus reflex responses in the masseter muscle to natural tooth contact usually consist of single inhibitory periods. In this respect they are like those induced by externally applied tooth pushing although occasionally there is a second inhibition, reminiscent of that seen with externally applied tooth taps.

The inhibitory effect of a chewing task on a human jaw reflex

This study was undertaken to investigate whether an inhibitory jaw reflex could be modulated by experimentally controlled conditions that mimicked symptoms of temporomandibular disorders. Reflecting on previous work, we anticipated that these conditions might suppress the reflex. Electromyographic recordings were made from a masseter muscle in 18 subjects, while electrical stimuli were applied to the upper lip. An inhibitory reflex wave (mean latency 47 ms) was identified and quantified. Immediately following an accelerated chewing task, which in most cases produced muscle fatigue and/or pain, the size of the reflex wave decreased significantly by about 30%. The suppression of inhibitory jaw reflexes by fatigue and pain may result in positive feedback, which may contribute to the symptoms of temporomandibular disorders. Future studies of temporomandibular disorder sufferers will help to determine whether such reflex changes reflect the underlying etiology and/or are a result of the temporomandibular disorder itself.

Jaw elevator silent periods in complete denture wearers and dentate individuals

Functional meaning and underlying mechanisms of jaw elevator silent period (SP) have still not been completely understood. Since complete denture wearers (CDWs) have no periodontal receptors in their jaws, the aim was to examine SPs in CDWs and to compare it with dentate individuals (DIs). Thirty six DIs (skeletal/occlusal Class I) and 24 eugnath CDWs participated. EMG signals were registered using the EMGA-1 apparatus from the left and the right side anterior temporalis (ATM) and masseter muscles (MM). Ten registrations of an open-close-clench (OCC) cycle were obtained for each individual. DIs had the average latency between 12.5 and 12.9 ms and always one single short inhibitory pause (IP) with complete inhibition of motoneurons (20.1-21.1 ms). On the other hand, in CDWs various types of SPs emerged: single or single prolonged SPs, double SPs, SPs with three IPs, periods of depressed muscle activity following the first, or the second IP, SPs with relative inhibition of motoneurons or even in several registrations the SP was missing. Unless more than one IP emerged, complete duration of inhibitory pauses (CDIP) was measured. CDIP varied from 37.17 to 42.49 ms. Average latencies were from 16.22 to 16.76 ms. Based on the results of this study it is obvious that both, the duration and the latencies were significantly longer in CDWs than in DIs (p<0.05), which can be explained by different mechanisms responsible for the muscle reflex behaviour.

Differences between inhibitory jaw reflexes evoked by stimulation of tooth pulp and across the adjacent alveolar process in man

OBJECTIVE

In humans, stimulation of nerves in or around teeth can evoke inhibitory jaw reflexes. Previous studies had suggested that there may be subtle differences in the timings of the responses. The aim of the present study was to investigate this by comparing reflexes evoked by electrical stimulation of a tooth and of the adjacent tissues in individual subjects.

DESIGN

Experiments were performed on 9 volunteers (3 male, 6 female). EMG recordings were made from the masseter muscle ipsilateral to the stimuli, whilst the subjects maintained a steady level of activity in the muscle. Reflexes were evoked by applying stimuli to an incisor tooth (pulpal stimuli) or across the adjacent alveolar process (transalveolar stimuli), using bipolar electrodes.

RESULTS

Two inhibitory responses were evoked in most (8/9) subjects. The first occurred at a shorter latency after transalveolar than after pulpal stimulation (12.3+/-0.5 ms vs 19.4+/-1.5 ms; P=0.0014, paired t-test). For technical reasons, it was not possible to make such comparisons for the second inhibitory responses in all the subjects. In 5 subjects where such a comparison was possible, the mean latency of the transalveolar-evoked response was again shorter than that of the pulpal-evoked response (56.4+/-2.8 ms and 58.8+/-5.3 ms, respectively), but this difference was not significant (P=0.5).

CONCLUSIONS

It appears that inhibitory jaw reflexes evoked from around the teeth are faster than those from the dental pulp. This observation could be due to differences between the peripheral afferent and/or the central pathways mediating the reflexes.

Reflex control of human jaw muscles

The aim of this review is to discuss what is known about the reflex control of the human masticatory system and to propose a method for standardized investigation. Literature regarding the current knowledge of activation of jaw muscles, receptors involved in the feedback control, and reflex pathways is discussed. The reflexes are discussed under the headings of the stimulation conditions. This was deliberately done to remind the reader that under each stimulation condition, several receptor systems are activated, and that it is not yet possible to stimulate only one afferent system in isolation in human mastication experiments. To achieve a method for uniform investigation, we need to set a method for stimulation of the afferent pathway under study with minimal simultaneous activation of other receptor systems. This stimulation should also be done in an efficient and reproducible way. To substantiate our conviction to standardize the stimulus type and parameters, we discuss the advantages and disadvantages of mechanical and electrical stimuli. For mechanical stimulus to be delivered in a reproducible way, the following precautions are suggested: The stimulus delivery system (often a probe attached to a vibrator) should be brought into secure contact with the area of stimulation. To minimize the slack between the probe, the area to be stimulated should be taken up by the application of pre-load, and the delivered force should be recorded in series. Electrical stimulus has advantages in that it can be delivered in a reproducible way, though its physiological relevance can be questioned. It is also necessary to standardize the method for recording and analyzing the responses of the motoneurons to the stimulation. For that, a new technique is introduced, and its advantages over the currently used methods are discussed. The new method can illustrate the synaptic potential that is induced in the motoneurons without the errors that are unavoidable in the current techniques. We believe that once stimulation, recording, and analysis methods are standardized, it will be possible to bring out the real "wiring diagram" that operates in conscious human subjects.

Dissociation of nociceptive modulation of a human jaw reflex from the influence of stress

In human beings, inhibitory jaw reflexes can be depressed by painful stimulation of remote parts of the body. Since similar effects can be produced by the stress of anticipating pain, we wished to investigate whether the effects of remote painful stimuli are dependent on stress. EMG recordings were made from a masseter muscle while subjects maintained activity in the muscle at approximately 12.5% of maximum using visual feedback. The protocols involved three sequences: (1) "standard controls" in which reflexes were evoked by electrical test stimuli applied to the upper lip; (2) "standard conditioning" in which painful electrical conditioning stimuli were applied over the sural nerve 100 ms before the test stimuli; (3) "random sequences" in which test-only and conditioning-test combinations were employed in a double-blind, random, order. Data are presented as means +/- SEMs. In the standard controls, the stimuli evoked clear inhibitory reflexes (latency 37 +/- 1.3 ms, duration 62 +/- 5.6 ms; n = 10) in all the subjects. During standard conditioning, the reflex magnitude was reduced significantly (by 50.0 +/- 8.5%, P = 0.0002, one-sample t-test). When the test-only and conditioning-test responses were extracted from the random sequences, there was also a significant reduction in the reflex magnitude following conditioning (by 34.6 +/- 5.5%, P = 0.0002, one-sample t-test) albeit less so than between the standard sequences (P = 0.03, paired t-test). A second series of experiments suggested that these lesser effects during the random sequences were not substantially due to any loss of temporal summation of the conditioning mechanisms. The evidence for this was that application of pairs of conditioning stimuli did not produce a significantly greater effect than single conditioning stimuli within a random sequence (39.9 +/- 9.6% as opposed to 32.7 +/- 9.1% reductions in the reflex, P = 0.117, paired t-test). Therefore since any stress in the random sequences would not have been "tied" to the conditioned responses alone, the effects of remote painful stimuli on this inhibitory jaw reflex cannot be entirely secondary to stress.

The role of periodontal mechanoreceptors in mastication

The aim of this review is to discuss what is known about the reflex control of the human masticatory system by the periodontal mechanoreceptors and to put forward a method for standardised investigation. To deliver mechanical stimulus in a reproducible way, the following precautions are suggested: the stimulus should be brought into secure contact with the area of stimulation, and slack between the probe and the area to be stimulated should be taken up by the application of a preload. It is also important to ensure that there is minimal simultaneous activation of receptor systems other than the periodontal mechanoreceptors. It is also necessary to standardise the method for recording and analysing the response.

A study on synaptic coupling between single orofacial mechanoreceptors and human masseter muscle

The connection between individual orofacial mechanoreceptive afferents and the motoneurones that innervate jaw muscles is not well established. For example, although electrical and mechanical stimulation of orofacial afferents in bulk evokes responses in the jaw closers, whether similar responses can be evoked in the jaw muscles from the discharge of type identified single orofacial mechanoreceptive afferents is not known. Using tungsten microelectrodes, we have recorded from 28 afferents in the inferior alveolar nerve and 21 afferents in the lingual nerve of human volunteers. We have used discharges of single orofacial afferents as the triggers and the electromyogram (EMG) of the masseter as the source to generate spike-triggered averaged records to illustrate time-based EMG modulation by the nerve discharge. We have then used cross correlation analysis to quantify the coupling. Furthermore, we have also used coherence analysis to study frequency-based relationship between the nerve spike trains and the EMG. The discharge patterns of the skin and mucosa receptors around the lip and the gingiva generated significant modulation in EMGs with a success rate of 40% for both cross correlation and coherence analyses. The discharge patterns of the periodontal mechanoreceptors (PMRs) generated more coupling with a success rate of 70% for cross correlation and about 35% for coherence analyses. Finally, the discharges of the tongue receptors displayed significant coupling with the jaw muscle motoneurones with a success rate of about 40% for both analyses. Significant modulation of the jaw muscles by single orofacial receptors suggests that they play important roles in controlling the jaw muscle activity so that mastication and speech functions are executed successfully.

Differentiation of nociceptive- from stress-induced modulatory influences on human reflexes

This paper describes a new protocol that addresses the question of whether, in human experiments, modulatory effects of remote nociceptive conditioning stimuli on reflex responses are mediated by the stress induced by the conditioning stimuli. The protocol has been illustrated by a study into the effect of a remote nociceptive conditioning stimulus on an inhibitory jaw reflex. Electromyograms were recorded from an active masseter muscle and inhibitory reflexes were evoked by applying electrical stimuli to the upper lip. This protocol utilised the application of discrete electrical conditioning stimuli applied to the sural nerve prior to the test stimulus. A preliminary experiment determined that the optimal interval between the conditioning and test stimuli, which produced modulatory effects was 100 ms. In the definitive study, computer software was used to deliver control and conditioned sweeps in a double-blind randomised sequence. This resulted in a "stress-equal" protocol in which the level of stress would be the same for both control and conditioned sweeps. Therefore any observed modulatory effects on the reflexes could not have been wholly secondary to stress. This protocol could be adapted to the study of the modulation of other reflexes or evoked sensations by nociceptive conditioning stimuli.

Response of human jaw muscles to axial stimulation of a molar tooth

The reflexes of the main jaw-closer muscles (masseter and anterior temporalis) on both sides of the jaw were investigated using surface electromyography to observe reflex activity following mechanical stimulation of the 1st right upper-molar tooth at various forces under a number of levels of jaw-muscle activity. As with analogous studies performed on the incisor, three distinct reflex events were identified in the EMG before the earliest conscious subject reaction: early excitation, inhibition and late excitation. However, contrary to observations found during studies on the incisor, excitation, not inhibition was the primary reflex response. The application of a local anaesthetic block around the stimulated molar showed that the primary agents in eliciting the observed reflexes were not contained within the periodontium of the stimulated tooth. A diminished representation of periodontal mechanoreceptors around the molar teeth and more elaborate root structures, hence a more solid connection to the jaw and consequently less tooth movement, were deemed the likely reason for the distinction between the reflex responses of the incisal and molar regions. In addition to the reflex studies, the minimum reaction time of a number of subjects was determined to permit the distinction of a reflex event and an event that could be a conscious subject reaction. It was found that the reaction time of the temporalis muscles was significantly shorter than those of the masseter, while no significant difference was found between the left and right sides. Overall, the data showed that the presence or absence of background muscle activity and subject variability were the main causes of changes in the reflex response, provided the level of the stimulus was greater than 3 N. The application of local anaesthetic had no impact on the reflexes evoked.

A device for investigating neuromuscular control in the human masticatory system

A new apparatus has been developed to study the control of mastication in humans. The subject places his/her teeth on fixed upper and mobile lower bite plates; the device then enables opening and closing movements of the lower jaw against a controlled resistance. It is also possible to vary the number of teeth in contact with the device during an experiment from the entire dental arcade to a single tooth. The specially designed lower bite plate is dynamic and allows for both rotation and translation of the lower jaw during movement, thus, permitting the natural curvilinear trajectory of the jaw. The lower bite plate can follow chewing initiated by the subject without resisting the movement ('no force' mode) via a dedicated microprocessor controlled compensation mechanism. Another function of the device is to inject a constant predetermined load onto the lower bite plate so that the subject 'chews' against a fixed resistance simulating rapidly yielding food bolus ('fixed force' mode). The device can be programmed to increase or decrease the force during the closing or opening phase of chewing by feeding the position information into the force compensation system so both position and force change in parallel, hence, simulating a bite onto a non-yielding, or sticky, food bolus ('normal chewing' mode). By use of a jaw position compensation mechanism, the device can actively move the lower jaw, following any imposed position pattern ('position controlled' mode). The chewing simulator also has a mode that holds the position at a fixed level and allows the force to change ('position hold' mode). Furthermore, the device can inject additional rapid or slow forces or displacements onto the lower bite plate in order to elicit reflexes so that the response of jaw muscles to such stimuli can be examined at various jaw positions, force levels, phases of motion and velocities. The different modes of the apparatus can be used to study the operation and feedback control of human mastication; in particular whether modulations in jaw muscle activity and reflexes are due to changes in force, velocity, position, chewing cycle phase or a combination of these factors.

Influence of methodological parameters on human jaw-stretch reflexes

The influence of methodological parameters and experimental conditions on the human jaw-stretch reflex was studied in healthy subjects in order to develop a reliable tool for investigation of the excitability of motoneuron pool. Short-latency excitatory reflex responses were evoked by a custom-made stretch device with the subjects biting on a jaw-bar with their front teeth. The displacement and ramp time of the stretches were accurately controlled and automatically triggered by a computer. The reflex responses were measured in the surface electromyogram (EMG) of the masseter and anterior temporalis muscles with online monitoring of the clenching level. The peak-to-peak amplitude of the jaw-stretch reflex was shown to be proportional to the level of EMG activity during isometric contractions, to increase proportionally with increasing stretch displacement at a given ramp time, and to decrease proportionally with increasing ramp time at a given stretch displacement. There were no significant differences in the reflex amplitude between repeated recordings within one session or between different sessions. Local anesthetic around the lower incisors as well as the upper incisors had no significant influence on the reflex amplitude. However, different biting positions on the bars of the stretch device significantly influenced the amplitude of the stretch reflex.

Jaw reflexes evoked by mechanical stimulation of teeth in humans

Jaw reflexes evoked by mechanical stimulation of teeth in humans. The reflex response of jaw muscles to mechanical stimulation of an upper incisor tooth was investigated using the surface electromyogram (SEMG) of the masseter muscle and the bite force. With a slowly rising stimulus, the reflex response obtained on the masseter SEMG showed three different patterns of reflex responses; sole excitation, sole inhibition, and inhibition followed by excitation. Simultaneously recorded bite force, however, exhibited mainly one reflex response pattern, a decrease followed by an increase in the net closing force. A rapidly rising stimulus also induced several different patterns of reflex responses in the masseter SEMG. When the simultaneously recorded bite force was analyzed, however, there was only one reflex response pattern, a decrease in the net closing force. Therefore, the reflex change in the masseter muscle is not a good representative of the net reflex response of all jaw muscles to mechanical tooth stimulation. The net response is best expressed by the averaged bite force. The averaged bite force records showed that when the stimulus force was developing rapidly, the periodontal reflex could reduce the bite force and hence protect the teeth and supporting tissues from damaging forces. It also can increase the bite force; this might help keep food between the teeth if the change in force rate is slow, especially when the initial bite force is low.

The role of gingival mechanoreceptors in the reflex control of human jaw-closing muscles

Electromyographic (EMG) experiments were undertaken to investigate the jaw reflexes evoked by activation of gingival receptors in 12 humans. EMG recordings were made from an active masseter muscle whilst ramp-plateau mechanical stimuli were applied to the gingiva. Stimuli with a constant rate of rise (0.2 N/msec) and a variable plateau force (up to 2 N), evoked a complex set of short- and long-latency inhibitory and excitatory responses. These occurred as a sequence of inhibition-excitation-inhibition-excitation, although not all of these elements were seen on every occasion. The median thresholds of these four responses ranged from 0.5 to 1 N but overall there were no significant differences between them (p > 0.05, Friedman's ANOVA). In other experiments, the same reflexes were recorded in response to application to the gingiva of 1 N ramp-plateau stimuli (5 msec rise time) and 1 N tap stimuli applied to the adjacent tooth. The application of a local anaesthetic agent to the stimulated gingiva produced reductions in the mean magnitude of almost all the responses but these were significant (p < 0.05; ANOVA) only for the long-latency inhibitions evoked by ramping the gingiva and the long-latency excitations evoked by either stimulus. It is concluded that mechanoreceptors in the gingiva can mediate long-latency inhibitory and excitatory jaw reflexes, and that these receptors may also contribute to long-latency reflexes evoked by tapping teeth. The scarcity of effects of gingival anaesthesia on the short-latency reflexes may be due to such responses being mediated by receptors deeper in the periodontium.